Who has low health literacy and does it matter for depression? Findings from aggregated and disaggregated racial/ethnic groups

Objectives: Health literacy is an important factor related to health outcomes and, ultimately, health disparities. Of the research that has been done, results have been mixed, which may be a reflection of how previous research primarily explored these relationships within aggregated groups. Thus, the present study sought to fill this gap in literature by exploring the relationships between determinants, health literacy, and depression within both aggregated and disaggregated groups. Method: Data from the 2007 California Health Interview Survey (CHIS) was used, which included information collected from 51,048 adult participants. A model of the determinants of health, health literacy, and depression was constructed based on Andersen's Model of Health Utilization and fit within both an aggregated ethnic/racial and immigration status group, as well as within disaggregated groups. Results: Results indicated that when comparing ethnic/racial groups, Latinx and AAPI groups had the lowest levels of health literacy. When comparing nativity groups, immigrants had lower health literacy levels than U.S.-born. Finally when looking at disaggregated groups, Latinx and AAPI immigrants had the lowest health literacy levels among all groups. Furthermore, health literacy determinants as well as the relationship between health literacy and depression differed depending on group demographics. Conclusions: This suggests that aggregated data analyses may obscure nuanced within-group differences, highlighting the importance of exploring health literacy within disaggregated groups. The results can be used to help inform the development of intervention or prevention-based programs that seek to improve health literacy and depression.